COVID-19 After Action Report - Larimer County Department of Health and Environment

Larimer County Department of Health and Environment COVID-19 After Action Report (AAR)

Prepared by The Blue Cell, LLC August 31, 2022

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Table of Contents

Incident Overview 4

Glossary of Acronyms 6

Purpose 7

Scope 7

Introduction 7

Pandemic Incident Overview 7

Event Timeline 9

Current Status of COVID-19 14

Pandemic Management 16

Incident Management Structure 16

Objectives and Outcomes 17

Operational Challenges 18

Continued Response Efforts 23

Recovery Efforts 24

After Action Report / Improvement Plan 24

AAR / IP Development Meetings 25

Data Collection and Analysis 25

Corrective Actions and Implementation 26

Feedback Surveys 26

Surveys General Findings 27

Strengths Identified by Survey Responses 28

Opportunities for Improvement by Theme 30

Final Improvement Plan 31

References 48

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Larimer County Department of Health and Environment (LCDHE)

NCIDENT OVERVIEW

Incident Name 2019 Novel Coronavirus

Report Dates December 2019 – August 2022

Scope

The COVID-19 virus outbreak turned into a global pandemic in March of 2020. At that time, the Colorado Governor declared a “State of Emergency.” Multiple public health orders were released to decrease disease transmission, provide a phased approach to reopening businesses and the economy, and to support enhanced disease control measures and case investigations.

MissionArea Response

Objectives

Ensure the health and safety of all people in Larimer County through the use of interventions such as social distancing, delivery of vaccinations, and the alleviation of medical surge.

Support economic and community response and recovery through equitable access to care, guidance, and public health interventions.

Participate in multi-jurisdictional coordination of response and recovery efforts, including on-going communications and messaging, strategic and operational integration with the Emergency Operations Center, and public outreach efforts.

Threat or Hazard Pandemic, COVID-19 Virus

Debrief Host Larimer County, Colorado

Participating Organizations Multi-jurisdictional and cross-disciplinary participation from all sectors and partners across all levels of government

Point of Contact SF Tomajczyk, Senior Emergency Preparedness and Response Coordinator

Larimer County Department of Health and Environment (LCDHE)

GLOSSARY OF ACRONYMS

AAR After Action Report

AAR/IP After Action Report and Improvement Plan

BOH Board of Health

CALPHO Colorado Association of Local Public Health Officials

CCI Colorado Counties, Inc

CDC Centers for Disease Control and Prevention

CDPHE Colorado Department of Health & Environment

CIAC Colorado Information Analysis Center

CSU Colorado State University

DHSEM Division of Homeland Security & Emergency Management

EOC Emergency Operations Center

ESF Emergency Support Function

FEMA Federal Emergency Management Agency

IC Incident Commander

ICS Incident Command System

IP Improvement Plan

JIC Joint Information Center

LC Larimer County

LCDHE Larimer County Department of Health & Environment

LPHA Local Public Health Agency

LRC Larimer Recovery Collaborative

NIMS National Incident Management System

OEM Office of Emergency Management

PCR Polymerase Chain Reaction

PHO Public Health Order

PIO Public Information Officer

POD Point of Dispensing / Point of Distribution

PPE Personal Protective Equipment

Larimer County Department of Health and Environment (LCDHE)

PURPOSE

This COVID-19 After-Action Report (AAR) serves as a record of how Larimer County and the Larimer County Department of Health and Environment (LCDHE) met organizational objectives during the COVID-19 pandemic response. The AAR contains a description of activities, key observations, and participant feedback. Additionally, it documents corrective actions for areas with opportunities for improvement and notes opportunities for sustaining strengths that were implemented during this response, including those which may be implemented in a future response. This AAR provides critical feedback from internal staff and from members of external organizations on the mission and task performances from early 2020 through August 31, 2022.

SCOPE

The development of this AAR was based on information and data collected up to the publish date of August 31, 2022. The report is primarily focused on the response efforts of the LCDHE. Although the worldwide pandemic is on-going, August 31, 2022, is considered the end date for these reporting efforts.

INTRODUCTION

COVID-19 will forever be a part of our lexicon. The virus’ far-reaching impact and change in our lives is remarkably difficult to fully absorb. Currently, the end of the pandemic is elusive, but we continue to hope for a near-future resolution that transforms COVID-19 into just another disease that we successfully manage. Until such time, healthcare and emergency medical care providers will continue to provide effective response and recovery efforts, while sustaining the work of encouraging people to do what they can to keep themselves safe, well, and healthy.

PANDEMIC INCIDENT OVERVIEW

A new coronavirus (COVID-19) was first detected in China. Shortly afterward, this virus was detected internationally and in all States and Territories of the United States. The initial outbreak was categorized as a pandemic in March 2020, triggering the actions of world governments and the implementation of home-based isolation and the advent of multiple emergency-approved vaccines.

Larimer County Department of Health and Environment (LCDHE)

After two years of coordinated efforts to slow and curb the progression of COVID-19, pandemic response efforts are on-going, focusing on multi-level responses for prevention, mitigation, and treatment. The length of the event and the fatigue surrounding the pandemic has presented many challenges, in different phases, in addressing public safety and compliance. Additionally, there have been challenges in ensuring community support around specific actions or measures implemented during the response.

The COVID-19 pandemic disruptions were expected in some cases, while others were unexpected. These disruptions produced their own cascading impacts felt across the Nation. Major event impacts included:

● The complete and then partial shutdowns of society

● Economic impacts caused by shutdowns

● Social distancing requirements

● Systems and services operating ineffectively

● Supply-chain disruptions and scarce resources

● Closure of in-person school and childcare

● Disproportionate effects on underserved and marginalized communities

● Social discord

Daily New Confirmed COVID-19 cases per million people, 7-day rolling

Larimer County Department of Health and

(LCDHE)

Event Timeline:

January - February 2020

● LCDHE initiates planning activities for COVID-19

● LCDHE initiates weekly calls with partners including schools, childcare centers and other key community partners

● On January 31, the World Health Organization declares a public health emergency

March 2020

● Larimer County activates the Emergency Operations Center (EOC) in preparation for COVID-19

● First two Colorado cases of COVID-19 reported

● Larimer County’s first confirmed COVID-19 case reported March 9, 2020

● State / County issues emergency declarations relating to presence of COVID-19

● President of the United States declares a National Emergency due to COVID-19

● All public and private schools in Colorado move to virtual learning

Larimer County Department of Health and Environment (LCDHE)

● Local and statewide Stay-at-Home orders issued to include closure of dine-in services, gathering restrictions (ten persons), and closure of non-essential businesses

● All Colorado non-essential medical procedures are suspended

April 2020

● State begins building 200-bed alternative care site at The Ranch

● Colorado and Larimer County Stay-at-Home orders replace Safer-at-Home orders

● The Governor issues mask order, requiring critical businesses and government functions to wear face coverings when within six feet of others

● Colorado COVID-19-related deaths = 1,000; Larimer County COVID-19-related deaths = 22

May 2020

● Larimer County Public Health Director issues an order requiring face coverings to be worn inside public spaces

● Governor’s office announces drafting of guidelines for restaurants to reopen at limited capacity by the end of the month

● LCDHE opens mass COVID-19 testing site, but results are highly delayed at CDPHE laboratory

● Larimer County receives a variance from the state to allow local businesses to reopen at increased capacity

● Colorado Department of Health and Environment (CDPHE) extends “Safer-at-Home” and suspends Voluntary and Elective Surgeries

● U.S. COVID-19-related deaths = 100,000

June 2020

● The Governor announces “Safer-at-Home and in the Vast, Great Outdoors.” The order allows Colorado residents to leave their homes for outside recreation as long as they wear face coverings and practice social distancing

● The Governor orders workers in critical functions to wear non-medical face coverings

● The Governor announces a new round of “Safer at Home” guidelines to further relax restrictions on the economy and society in as safe a way as possible

Larimer County Department of Health and Environment (LCDHE)

July 2020

● The Governor issues an order requiring individuals in Colorado to wear non-medical face coverings over their nose and mouth

● The Governor amends and extends Executive Orders “Safer-at-Home and in the Vast, Great Outdoors”, to include ceasing alcohol beverage sales and limiting on-premises consumption between 10:00 P.M. and 7:00 A.M. each day

● School readiness planning: major schools announce hybrid learning models for the fall

● Larimer County COVID-19 cases = 1,000, Larimer County COVID-19-related deaths = 34

August 2020

● Public schools and many charter schools in Colorado and Larimer County announce 100% remote learning to start the school year

● COVID-19 is the third leading cause of death in the U.S.

September 2020

● CDPHE issues a Public Health Order 20-35 setting forth the requirements for implementation of Safer-at-Home Dial. Larimer County = Level Yellow: Concern

October 2020

● CDPHE issues Public Health Order which limits public and private gatherings in all levels to 10 individuals from no more than two households

● Larimer County Public Health Director issues an order limiting gathering sizes, creating a local last call, limited recreational sports, and additional contact tracing protocols for businesses

● The 14-day case rate doubles between October 1 and October 31 in Larimer County

● CSU Veterinary Diagnostics Laboratory begins to test for Larimer County COVID-19 samples collected at LCDHE testing sites, reducing delayed results

● Colorado is the first state to use a mobile phone application to notify users of COVID-19 exposure

● Colorado COVID-19-related deaths = 2,000; Larimer County COVID-19 cases = 4,899, Larimer County COVID-19-related deaths = 57

Larimer County Department of Health and Environment (LCDHE)

November 2020

● As a result of a Public Health Order issued by CDPHE, risk levels are categorized based on colors: Level 1 is now Level Blue, Level 2 is now Level Yellow, Level 3 is now Level Orange, and Level 4 is now Level Red

● Larimer County moves to Level Red: Severe Risk

● Colorado COVID-19 dial framework adds “Extreme Risk” level based on hospital capacity and shortages of staff and/or personal protective equipment (PPE)

● LCDHE launches “Prevention Starts at Home” communications campaign to encourage residents to avoid large gatherings during the holidays

● Larimer County COVID-19 cases = 10,000, COVID-19-related deaths = 80

December 2020

● CDPHE receives first delivery of Pfizer vaccine - State implements phased mass vaccination rollout

● Colorado launches a framework for qualifying businesses to operate under loosened restrictions. On December 22, Larimer County’s “Level Up” program is among the first approved in the state

● Colorado COVID-19-related deaths = 3,000; Larimer County COVID-19 cases = 16,850, Larimer County COVID-19-related deaths = 100

January 2021

● 20,000 Larimer residents have received at least one dose of COVID-19 vaccine

● LCDHE mass vaccination site opens at The Ranch Events Complex

● The Governor moves all counties in Level Red to Level Orange

● Colorado COVID-19-related deaths = 4,000; Larimer County COVID-19 cases 19,997, Larimer County COVID-19-related deaths = 207

February 2021

● CDPHE announces an update to Colorado’s COVID-19 Dial 2.0

● Teachers, and 65+ years old are now eligible for vaccines

● LCDHE initiates on-site and mobile vaccination clinics throughout the county with the focus on equitable access to the vaccine

● Colorado COVID-19-related deaths = 5,000; Larimer County COVID-19 cases = 22,150, Larimer County COVID-19-related deaths = 228

Larimer County Department of Health and Environment (LCDHE)

March 2021

● Federal, state, and local agencies partner to set up a mass vaccination site at The Ranch complex in Loveland, vaccinating thousands of people each week

● Over 1,000,000 Coloradans have received at least one vaccine and 700,000 Coloradans are fully vaccinated

● Colorado COVID-19-related deaths = 6,000; Larimer County COVID-19 cases = 24,637, Larimer County COVID-19-related deaths = 236

April - June 2021

● Vaccine authorized for 16+ years old

● Vaccine authorized for children ages 12 and older

● The Governor ends state universal face covering order; however, face coverings remain required in health care settings and congregate living facilities in Colorado

● Larimer County Public Health Director issues the Amended Eighth Public Health Order to require face coverings in all public indoor spaces on April 16

● Public Health Director expires face covering order at the end of the school year

● Larimer County COVID-19 cases = 29,867, Larimer County COVID-19related deaths = 257

July - September 2021

● LCDHE mobile, equity-based clinics continue throughout the county and operations move from community-based sites to LCDHE fixed locations

● Delta Variant represents 99.2% of Colorado cases

● Larimer County COVID-19 cases = 37,933, Larimer County COVID-19 -related deaths = 296

October – December 2021

● Due to Delta variant surge and hospitals being full and at overflow capacity, Larimer County Public Health Director re-issues face-covering order in public indoor spaces at the end of October

● First cases of COVID-19 Omicron variant are reported in Larimer County

● Promising new treatments for COVID-19 become available

● Children ages 5-11 years of age became eligible to receive COVID-19 vaccination

Larimer County Department of Health and Environment (LCDHE)

● Larimer County COVID-19 cases = 55,335, Larimer County COVID-19 -related deaths = 417

January - March 2022

● By mid-January, the Delta wave has receded, and the Omicron wave causes a dramatic increase in cases, with a case rate of 1,936 per 100,000 and a percent positivity rate of 32%

● By mid-February, the case rate decreases to 322 per 100,000 and percent positivity drops to 9%; the Larimer County face covering order is rescinded

● Hospital admissions drop to below 10 per 100,000

● A second booster dose of either Pfizer or Moderna COVID-19 vaccines is recommended for adults ages 50 years and older and certain immunocompromised individuals

● In March, the White House launches the Test-to-Treat initiative to give people quick access to life-saving COVID-19 treatments

April - June 2022

● Rapid at-home COVID-19 tests become widely available for distribution at no cost through state, local, and federal agencies

● Novavax COVID-19 vaccine, the first non-mRNA protein-based product, is approved for use

July - August 2022

● Children aged 6 months and older become eligible to receive COVID-19 vaccination

● Bivalent, Omicron-specific booster vaccine in final stages of approval

Current Status of COVID-19

Approximately 120,000 new cases of COVID-19 are reported in the United States each day2 with 1,000 new cases reported daily in Colorado;3 82 new COVD-19 cases were reported in Larimer County on August 31, 2022. During the month of August 2022, 147 COVID-19 related deaths were reported in Colorado3, and three COVID-19 related deaths occurred among Larimer County residents.4

Vaccination remains a primary goal, since data indicates that unvaccinated individuals remain most at risk of severe disease, hospitalization, and death. LCDHE and other healthcare providers in the region continue to provide a

Larimer County Department of Health and Environment (LCDHE)

large-scale vaccination response. This response continues to prioritize vaccine outreach to under-resourced groups and groups at greatest risk for detrimental health outcomes related to COVID-19 infection.

LCDHE is continuing to promote and provide at–home tests to residents. Testing is critical to controlling the spread of COVID-19, providing important information about viral movement and to help monitor outbreaks in the community.

Treatment remains an essential strategy in responding to the pandemic. LCDHE continues to work to link residents recently diagnosed with COVID-19 to treatment resources in the community

Throughout the pandemic, LCDHE has, and continues to, closely monitor various indicators on a public-facing dashboard. Current and historical data including case rates, hospitalization rates and admissions, Intensive Care Unit (ICU) admissions, COVID-19 related deaths, outbreaks by facility and vaccination data are available on the Larimer County COVID-19 dashboard, located at www.larimer.gov/COVID.4

Larimer County Department of Health and Environment (LCDHE)

PANDEMIC MANAGEMENT

The pre-pandemic preparedness activities undertaken by LCDHE included, among other activities, reviewing the LCDHE Pandemic Response Plan. Planning partners who aided in the development of this plan included representatives from local emergency management, pre-hospital medical care and other first responder agencies, hospitals and the healthcare coalition, and other partner/stakeholder agencies, organizations, and departments within Larimer County. Many of these planning partners also participated in one or more pandemic-themed exercises facilitated by LCDHE.

The Pandemic Response Plan established best practices for the organization and management of a pandemic response. Although many new processes were developed to address the dynamic needs of managing this pandemic, the base plan served LCDHE well in achieving the strategic goals of reducing risks to the community and maintaining a functioning healthcare system during an extraordinary healthcare disaster.

Incident Management Structure

The Larimer County EOC was activated early in the pandemic to coordinate and support all pandemic-related activities. LCDHE staff served in many assignments, at all levels of the Incident Command Structure, and provided senior level command/subject matter expertise throughout the timeline. Since EOC demobilization, the incident coordination is managed by LCDHE, with continued support from Larimer County personnel, including emergency management.

Larimer County Department of Health and Environment (LCDHE)

Objectives and Outcomes

The primary operational objectives set for the management of the pandemic were to:

● Raise awareness about the need for a layered approach to COVID-19 prevention, and promote the implementation of multiple prevention strategies, including vaccination, without imposing mandates and restrictions, if possible

The desired outcomes were:

● Children remain learning in-person at schools and childcares with minimal disruptions

● Hospitals maintain adequate resources for all critical health care needs

● Vaccination uptake and completion is maximized in Larimer County

Regarding best practices for distinct audiences, LCDHE sought to influence these outcomes by:

● Building trust with residents and community partners

● Answering questions and providing resources

● Inspiring community level and individual behavior change

● Providing equitable vaccination opportunities

Operational Challenges

As part of the AAR/IP development process, it is valuable and appropriate to consider the context and environment experienced by staff, volunteers, and partner agencies during the pandemic response. This consideration helps to describe the construct of decisions made, processes used, and the impacts of both. In this section, a description of context and environmental factors are provided in the following themes:

● Communication

● Health Equity

● Community Outreach

● Partnerships

● Incident Management

● Training and Exercises

Communication

Internal/External Communication and Information Sharing

Communication and information sharing presented a great challenge during Phase 1 and at key roll-out time frames during the pandemic (e.g., vaccine rollouts, changes in school guidance, etc.). LPHAs were frequently notified of changes in COVID-19 guidance by the CDC or state-level at the same time that the public was notified of the changes, which created difficulties in conveying timely information about guidance changes to the public and partners.

Timely and Accurate Information

In Phase 1, the demand and influx of public inquiries was overwhelming, even with setting-up a Joint Information Center (JIC) almost immediately.

County Department of Health and Environment (LCDHE)

Risk Communication and Coordinated Messaging During Periods of Uncertainty

Conveying succinct and easily digestible scientific information to the public about an emerging pathogen, which was constantly changing, created a unique challenge in retaining public trust.

Social Media

The overwhelming impacts of disinformation and misinformation existing on social media platforms presented a challenge for effectively communicating about COVID-19.

Incorporating Data in Messaging

In Phase 1, a COVID-19 dashboard was developed and maintained as a way for residents to monitor conditions, including case counts, hospitalizations, outbreaks, and deaths; however, the pace and complexity of the pandemic, along with the variety of data metrics available nationally, created multiple challenges for clearly communicating conditions. This was especially challenging as misinformation and disinformation spread about pandemic-related data.

Crisis Communications

Communicating information during a crisis of this magnitude with rapidly evolving guidance was difficult. Ensuring that public-facing officials have strong talking points early in the pandemic is a priority.

Health Equity Health Literacy

Ensuring health literacy during the pandemic was not only a challenge due to inequities, but additionally due to disinformation and the polarizing nature of the response.

Equity and Inclusion

Effective partnerships with shared vision and commitment to outcomes are essential for community-based solutions for advancing health equity. Many different stakeholders are needed for this, such as public health agencies, government and municipalities, hospitals and health systems, community-based organizations, faith-based organizations, businesses, the education sector and academia, and housing, justice, and other agencies serving the community.

Larimer County Department of Health and Environment (LCDHE)

Community Outreach

Compliance

Obtaining compliance with public health orders (PHO) presented unique challenges during Phases 2 and 3, when many state PHOs were lifted or expired, and LCDHE and other local public health agencies in the state implemented local PHOs to address rising numbers of cases and hospitalizations. PHOs varied during this timeframe from county-to-county, making communication about PHOs and obtaining compliance with the various PHOs difficult.

Behavioral Health Support

Individuals in need of behavioral health support were often identified through case investigation, contact tracing, or through the JIC. Ensuring that individuals in need of behavioral health support were properly identified, referred to services, and had received follow-up presented challenges due to the overwhelming need.

Partnerships

Collaboration

The earliest phase of the pandemic created both opportunities and barriers for effective collaboration. LCDHE had many municipal, governmental, law enforcement, academic, and health partners who were all invested and interested in supporting efforts for the response. In the middle and later phases of the pandemic response, collaborations were both strengthened and enhanced. Simultaneously, the polarizing nature and fatigue surrounding the response also created hardships in the ability to effectively collaborate.

State/Federal Communication

Working through the complexity of multi-governmental relationships presented a range of challenges and barriers across the nation. To combat this, there has been a large movement since the onset of COVID-19 within public health at local, state, and federal levels to address barriers and make improvements. LCDHE recognizes that responding to this national and global need is essential and needed to engage in efforts with state and federal partners to make lasting improvements during emergencies and otherwise.

Incident Management

Decision-Making Process

County

of Health and

With a rapidly evolving response, ensuring that all decision-makers had opportunities to be involved and engaged in the decision-making process had to be balanced with the need to make timely decisions that affected multiple partners/sectors.

Enforcement of Public Health Orders

Enforcement of public health orders was a challenge throughout all three phases of the response. A very high volume of complaints was received on a daily basis and a team was assembled to address these issues using education as the first step, prior to moving towards enforcement. Due to the economic strain the pandemic put on businesses, use of punitive enforcement of orders was not a priority, except in cases where all other options and efforts had been exhausted. The majority of businesses did their part to help lessen the impact of COVID-19 on our community and a very small percentage required more formal notices of violation or further action for being openly defiant of the public health orders put in place.

Finance

Funding rollout was a complex process between federal to state to the local levels. The guidance around the funding changed frequently through Phases 1 and 2, in particular. Regular participation in forums and conversations with our funders was beneficial. Challenges were clearly communicated that described funding restrictions and repeated changes to guidance and the impacts presented to us and our communities. Improvements have been made recently, but increased communication between federal and state and state and local groups when funding considerations and grant guidance is developed is required for long-term success.

Logistics

During Phase 1, PPE was scarce and healthcare facilities, long-term care facilities, and other partners were required to compete for needed medical supplies and PPE. LCDHE was quickly overwhelmed by the stop-gap requests for PPE from healthcare partners during Phase 1.

Program Implementation

In Phase 1, due to the acceleration of the pandemic, communications about decisions impacting staff and/or partner agencies was a challenge but plans to communicate decisions impacting either staff or partner agencies were developed and implemented as the response moved beyond Phase 1.

Larimer County Department of Health and Environment (LCDHE)

Clinic Operations

Early months of vaccination efforts had inconsistencies with vaccine supply/availability and the allowability for vaccinating members of the public. Inadequate clinic personnel to work at mass events, and limited sites for large-scale operations were also challenges early in this stage. There were additional early difficulties to streamline operating systems for managing patient registration and vaccine administration requirements resulting in disorganization and frustration for staff and the public during the initial rollout. The mass nature of needing to vaccinate so many persons made equitable rollout to under-represented groups problematic. Over the course of the vaccination phases, significant enhancements and improvements were made and vaccination uptake in Larimer County has consistently been higher than in many counties, especially in booster uptake and vaccination of children. Within months of the initial roll-out, supply improvements, efficiencies to ensure adequate staffing, and ability to ensure persons could get into clinics quickly and receive a vaccine safely and efficiently were notable and effective.

Staff Care / Support

When faced with a pandemic or emergency of this magnitude, public health agencies and other organizations are required to compete for staffing resources. LCDHE hired a large number of temporary staff to support COVID-19 efforts early in the pandemic and during various surges. While some temporary positions may be the best fit for specific positions, having a better onboarding infrastructure and seasoned leadership within the response, as well as positions filled by staff who are appropriately skilled and trained for the role in which they are working, will ensure that expectations are best managed.

Training and Exercises

Emergency Preparedness and Response Training

LCDHE staff are required to take ICS training as emergency responders; however, emergency preparedness-and-response trainings, exercises, and drills typically focus on short- to medium-term incidents and disasters. Adhering to ICS tenets and structure for an unprecedented, multi-year response that included several distinct waves of the pandemic was a unique and challenging experience since LCDHE staff returned to day-to-day health department operations during times of non-surge and were required to serve as emergency responders during times of COVID-19 surge to assist with the response.

Larimer County Department of Health and Environment (LCDHE)

Continued Response Efforts

Vaccines

Vaccines are the most powerful tools available to prevent serious illness, hospitalization, and death from COVID-19. Safe and effective, both primary vaccinations and boosters for adults and children afford protections against COVID-19 and new variants of concern. Maintaining equity in vaccine availability for marginalized and underserved populations and to populations at greatest risk for poor outcomes from COVID-19 is imperative.

A total of 11 million vaccine doses have been administered to Coloradoans. At the time of this reporting, Larimer County residents have received a total of 689,819 doses of COVID-19 vaccine, with 74% of the eligible population having received at least one dose. Nearly 70% of Larimer County’s population is fully vaccinated against COVID-19.

COVID-19 Testing

LCDHE is ensuring continued equitable access to COVID-19 testing for residents through a variety of channels in communities. LCDHE’s current focus is to provide testing kits to individuals who may otherwise not be able to access them. We are also partnering with CDPHE to make tests more broadly available so that people can protect themselves and those around them.

Data Monitoring and Disease Detection

In an effort to prepare communities for any changes in the current response, LCDHE will continue the monitoring of critical data and use available tools to detect any changes in conditions that may require a different level of response to COVID-19, including outbreaks, community transmission, variants, and health care system capacity. LCDHE staff will continue to work closely with partners at the local, state, and federal levels to maintain a comprehensive view of disease transmission trends.

Health System Capacity

LCDHE continues to monitor the impact of COVID-19 on the health system and supports response and workforce resiliency across the public health and health care systems through multi-agency coordination. Other operational priorities for LCDHE include keeping healthcare workers safe, well-equipped, and prepared.

Larimer County Department of Health and Environment (LCDHE)

Treatments and Therapeutics

LCDHE is monitoring the supply of current and new COVID-19 therapeutics for preventing and treating COVID-19 and implementing distribution strategies as new opportunities arise.

Recovery Efforts

The Larimer Recovery Collaborative (LRC) published the COVID-19 Long-Term Recovery Plan5, dated December 1, 2020, which documents the community’s collective unmet recovery needs caused by the on-going pandemic through August 2020. The plan provides a view of the Larimer County government’s planning efforts to address the impacts of the pandemic and includes the following major sections:

● Background on the COVID-19 event

● Larimer County’s recovery efforts to date

● Event impacts and unmet needs across the three Focus Areas of this plan (1) Workforce & Business Services, (2) Government, Education, & Policy; and, (3) Community Support Services

● Identified unmet needs relating to the pandemic

● Lessons learned thus far from the events that have transpired

● Next steps for continued recovery

The document states that at the time of writing, the community was still experiencing some unmet needs relating to the pandemic, and that LRC identified the necessity of recovery efforts to reduce the community’s collective social vulnerability, among many other needs identified in the plan.

AFTER ACTION REPORT / IMPROVEMENT PLAN

An After-Action Report / Improvement Plan (AAR/IP) is a two-part document that consists of a Report (AAR) and an Improvement Plan (IP) that serves as the management tool for identifying and implementing corrective actions leading to improved policies, procedures, systems, and/or processes.

The AAR section includes feedback, comments, and key information from surveys and in-person After-Action Review meetings. The AAR focuses on the analysis of task performance and identifies the strengths and areas for improvement as observed by the respondents.

Larimer County Department of Health and Environment (LCDHE)

AAR / IPDevelopment Meetings

LCDHE contracted with The Blue Cell, LLC, to conduct multiple Hotwash meetings with attendee representatives from a variety of internal departments, groups, and external agencies to obtain observations and feedback not already provided in surveys. The feedback has been incorporated with the survey comments and the overall IP matrix.

The Hotwash meetings, conducted in-person and virtually, were organized as opportunities for similar groups to discuss successes and challenges and to provide feedback. The Hotwashes were organized into the following groups:

● Healthcare, EMS, and Non-Governmental Organizations

● Leadership and Decision-Makers

● Emergency Management & Law Enforcement

● Schools, Childcare Facilities, and Colorado State University (CSU)

● Chambers of Commerce and Businesses

● LCDHE staff

Data Collection andAnalysis

The COVID-19 AAR/IP should not be viewed as an academic work or scientific study. Instead, this document serves as a guide to understanding the observations and feedback describing the personal experiences of staff, volunteers, and partner agencies who worked one or more phases of the pandemic response.

Analysis Goal

The goal of the data analysis was to determine the respondents’ opinion of the effectiveness of their own performance of critical tasks and the effectiveness of processes and procedures used in performing those tasks.

Analysis Process

The analysis of the collected data was performed through the review of all provided comments. The data analysis process provided two significant types of results: (1) Common Experiences - as reflected in word counts of common terms and concepts, and (2) Specific Suggestions for improvement. All comments were separated into strengths and areas for improvement. Then, the opportunities for improvement comments were further separated into key areas and functions.

Larimer County Department of Health and

(LCDHE)

Root-cause analysis was used by LCDHE to discover the primary causes of missed objectives and to determine appropriate corrective actions.

CorrectiveActions and Implementation

Corrective actions are concrete, actionable steps that are intended to resolve capability gaps and shortcomings identified by staff and/or members of external organizations and agencies. Corrective actions are created by using the S.M.A.R.T. objective model, where the action is Specific, Measurable, Achievable, Realistic, and Time-bound. By identifying corrective actions and successful strategies implemented during the response, stakeholders are able to demonstrate tangible improvements in policies, processes, and procedures.

FEEDBACK SURVEYS

LCDHE provided access to on-line surveys developed by The Blue Cell, LLC, for staff and members of external partner organizations and agencies to provide additional comments for inclusion in this report and in the IP. The surveys asked six questions and provided space for general comments for each of the three defined operational phases, which were:

● Phase One – beginning of pandemic - to - the distribution of COVID-19 vaccine (January 2020 to December 2020)

● Phase Two – distribution of vaccine - to - before the presence of the Omicron variant (December 2020 to November 2021)

● Phase Three – presence of Omicron variant in Larimer County (December 2021 - to - report date of August 2022)

Survey Questions

● In what position(s) did you serve as part of the COVID-19 response?

● What went well as part of your role in the response to COVID-19?

● What went well in the overall response to COVID-19?

● What is something that could be improved upon as part of your role in the response to COVID-19?

● What is something that could be improved upon in the overall response to COVID-19?

● What is something that you have learned or taken with you from your response to COVID-19 that you can use as part of your routine work?

● General Comments

Larimer County Department of Health and Environment (LCDHE)

Survey Respondents

Survey respondents and After-Action Review Meeting attendees stated that they held or still hold these working positions during the pandemic, listed alphabetically:

Accountant

Accounting Manager

Administrative Specialist

Behavioral Health Response

Board Of Health Member

Case Contact and Monitoring

Communications

Compliance

Contact Tracer

Bilingual Comms Specialist

Case Investigator

Department Manager

Department Specialist

Disease Intervention Specialist

Elected Official

Emergency Management

Epidemiologist

Equity Coordinator

AAR IP Development Statistics

Written Surveys Submitted = 23

Online Surveys Submitted = 76

AAR Meeting August 3 & 9, 2022 = 101 attendees

Unique comments = 867

Major Improvement Themes = 6

Surveys - General Findings

Executive Director

First Responder

Lead Administrator

Leadership

Logistics Team Member

Medical Contract Admin

Mobile Clinic Coordinator

Nurse Practitioner

Nursing Supervisor

Operations Co-Lead

Operations Long Term Care

PCR Tester

PIO / JIC Personnel

Public School COVID-19 Liaison

Superintendent of Schools

University Employee

WIC Educator

The majority of respondents to the surveys and the participants of the AAR meetings shared a general satisfaction of working in the pandemic response. Additionally, nearly all respondents shared comments that LCDHE was supportive of staff and effective in the management of the event to date.

County Department of Health and Environment (LCDHE)

There were several common themes in their positive experiences and observations. By far, respondents believe that communication was very effective and timely, that leadership and collaboration with internal and external partners was effective, and there was good teamwork all-around.

Regarding the wide range of comments related to opportunities for improvement, the comments seem to be based on individual experiences and there were only a few commonly shared less-positive experiences. The collective feedback reflects a concentration of comments for improvement in the areas of balancing workload and managing staff burnout, sustaining communications and collaborations, and process management improvements.

Respondents reported that they experienced significant challenges caused by the high amount of change driven by the dynamic landscape of the pandemic, the confusion and frustration resulting from the frequent and untimely releases of State Public Health Orders, the increasingly negative public discord, general feelings of being in an uncertain and unsafe environment, and difficulties navigating the job due to various combined factors.

Strengths Identified by Survey Responses

Phase One

For Phase One, which is the beginning of pandemic and ending before vaccine distribution (January 2020 to December 2020), respondents’ comments indicate a wide satisfaction level for business and public outreach efforts, the effectiveness of communications and coordination efforts, and recognition of major efforts of leadership to guide and support staff.

Phase One Common Words – Number of Occurrences in Responses

Public Outreach - 25

Communication - 20

Leadership - 17

Coordination - 16

Staff Support - 16

Community Safety – 15

Teamwork - 15

Collaboration - 13

Dedication - 10

Flexibility - 9

Messaging - 9

Innovation - 7

Staff safety - 6

Talent - 4

Grants - 4

Phase Two

For Phase Two, which is after vaccines became available for distribution to the community (December 2020 to November 2021), respondents’ comments reflect several significant developments, notably in overall process improvements from phase one to phase two, the positive community impact from the availability of vaccine clinics and effectiveness of clinic operations, the expansion of business and public outreach efforts and resources, and improvements to the general support of staff

Phase Two Common Words – Number of Occurrences in Responses

Process Improvements – 23

Clinics - 11

Outreach - 7

Staff Support - 6

Vaccines - 6

Phase Three

Capabilities - 4

Equity - 4

Hope - 3

Training - 3 Workload - 3

For Phase Three, which begins with the presence of the Omicron variant (December 2021 - to - August 2022), respondents’ comments reflect perceptions of significant process improvements, internal and external collaborations, equity in vaccines and in outreach efforts, and staffing level and workload stabilization.

Phase Three Common Words – Number of Occurrences in Responses

Process Improvements - 10 Collaboration - 5

Equity - 5

Staffing - 5

Respondents’ General Consensus

Outreach - 4 Workload - 4

Clinics – 3

Coordination - 3

When all comments are aggregated and analyzed, there is a general consensus that first, everyone worked hard to make all efforts as effective and efficient as possible under extremely stressful situations. Additionally, the comments reflect a unified, positive voice in stating that:

1. Outreach efforts to the business community and the public were accomplished as successfully as possible;

2. There were various efforts to provide support for staff and staff had a deep appreciation for those efforts;

Larimer County Department of Health and Environment (LCDHE)

3. As time passed, there were significant process improvements in nearly all functional areas;

4. The processes for internal/external communications were appropriate and effective;

5. Collaboration and coordination with staff and partners were appropriate and effective;

6. Equity in vaccines and in outreach efforts improved greatly over the course of time and met strategic goals; and,

7. Staffing shortages were addressed over time and workload stabilization improved dramatically in Phase Two.

All Positive-leaning Common Words – Number of Occurrences in Responses

Outreach - 36

Staff Support - 25

Process Improvements – 23 Communication - 22

Collaboration - 20

Coordination - 19 Leadership - 18 Teamwork - 16

Community Safety – 15 Clinics - 14

Messaging - 12 Dedication - 10

Equity - 9 Flexibility - 9 Grants, Grants & Funds Mgt - 8 Capabilities - 4 Experience - 4 Talent - 4 Training - 4 Hope - 3 Response - 3 Support - 3 Trust - 3

Opportunities for Improvement by Theme

Respondents had 867 comments that provided unique descriptions of opportunities for improvement. Those comments were analyzed and placed into the following six themes:

● Communication

● Health Equity

Partnerships

●

Outreach

Management

Training and Exercises

Larimer County Department of Health and Environment (LCDHE)

These categories are used throughout the IP, located in the following section, in order to maintain the connection between the comments and their various interactions.

FINAL IMPROVEMENT PLAN

The IP section of this document contains three-column tables that are grouped into the six themes and contain: (1) Key areas for improvement, (2) Suggestions for improvement based on themes identified in survey and hotwash feedback comments and, (3) Corrective actions to resolve the identified gaps.

LCDHE leadership provided input on the corrective actions and objectives based on suggestions from Blue Cell, LLC. Many corrective actions will be implemented in the weeks and months following the release of this AAR/IP document. Some corrective actions are identified as process or strategy improvements to be implemented during the next emergent incident.

Example of the IP format:

Training & Exercises

Key Area Suggestion

Emergency Preparedness and Response Training

● Establish an ICS/NIMS Training policy for the Department that aligns with FEMA requirements and details courses based on roles within Incident Command

●

Corrective Actions

Within 6 months, revise the training and exercise program to align with FEMA requirements.*

Note: Corrective Actions followed by an asterisk (*) in the IP indicate recommendations that should be implemented during an emergent incident, as opposed to Corrective Actions that should be implemented within defined timelines. The items with asterisks will also contribute to a Job Action Sheet for the Command and General Staff to follow in the event of an emergent incident as noted in the IP section of this document.

Larimer County Department of Health and Environment

Communication

Key Areas Suggestions

Internal / External Communication and Information Sharing

● Develop or improve processes for internal communication and information sharing within command structure and between working groups, between internal and external partners, with departments not engaged in response, with stakeholders, and with the community.

● Develop new and/or improve processes for clarifying, defining, optimizing communications and/or messaging.

● Develop or improve processes for streamlining meetings for efficiency and maintain ongoing communications with staff and partners.

Corrective Actions

● During an emergent incident, distribute the Incident Action Plan (IAP) and related updates for each operational period to all Department staff (not just those within the Command and General Staff structure), and relevant decision makers and stakeholders (incident dependent) within 12 hours. *

● Within six months, develop a plan that identifies which external partners and stakeholders (e.g., healthcare providers, elected officials, schools, childcare, higher education, business community, healthcare coalition) will be contacted and briefed during an emergent situation, how frequently and in what format(s).

● During an emergent incident, expand access to the Department’s internal Joint Information Center website for all staff within 72 hours of opening the JIC. *

Larimer County Department of Health and Environment (LCDHE)

Timely and Accurate Information

● Develop or improve processes for providing needed information addressing public inquiries.

● Optimize websites and other resources as single source references.

● Provide scripts and/or templates for navigating common topics.

● Provide access to pre identified resources and current information for staff assisting the public.

● Within a week of an emergent incident, create and customize a series of online inquiry forms and email groups unique to specific audiences (e.g., staff, general public, businesses, healthcare providers, first responders) to be answered by public information staff, subject matter experts, and/or the Joint Information Center.*

● Within a week of an emergent incident, create and customize a bidirectional, interactive text line for public inquiries. *

● Within a week of an emergent incident, enhance and customize the Department’s website FAQs by providing direct linkages to vetted information resources to avoid the need for constantly updating customized web pages. *

● During an emergent incident, establish and customize a social media presence within 24-hours to provide timely and accurate information to the public. *

Larimer

Conflicting Public Information & Misinformation

● Create opportunities for the public to give input (e.g., forums).

● Evaluate goals and develop or improve processes for supporting community members.

● Develop or improve processes for managing complaints and problems.

Risk Communication and Coordinated Messaging

During Periods of Uncertainty

● Develop or improve processes for clarifying, defining, optimizing communications and/or messaging.

● Develop or improve collaborative processes for external communication and information sharing with partners and stakeholders.

● Optimize websites and other resources as single-source references.

Coronavirus

● Within a week of an emergent incident, create and customize a series of online inquiry forms and email groups unique to specific audiences (e.g., staff, general public, businesses, healthcare providers, first responders) to be answered by public information staff, subject matter experts, and/or the Joint Information Center.*

● Within 72-hours of an emergent incident, engage community champions (e.g., behavioral health, faith-based organizations) to identify issues that may adversely impact the public and/or result in conflicting information and misinformation. *

● Within 24 hours of an emergent incident, establish a schedule for communicating with relevant public information partners (e.g., County PIO, State PIO, news media) during an incident to clarify, define, and optimize messaging appropriate to the intended audience. *

Larimer County Department of Health and Environment (LCDHE)

Novel Coronavirus

Social Media

● Develop or improve processes for rumor control/misinformation management.

● Develop or improve processes for clarifying, defining, optimizing communications and/or messaging for social-media platforms.

● Improve processes for expanded social media presence that keep the bi directional lines of communication open.

● During an emergent incident, establish and customize a social media presence within 24-hours to provide timely and accurate information to the public. *

● During an emergent incident, analyze data on a weekly basis from social media platforms (e.g., Facebook, Instagram, Twitter) to maximize engagement and determine what types of posts and content are the most well-received. *

Larimer County Department of Health and Environment (LCDHE)

Incorporating Data in Messaging

● Develop or improve processes for data inclusion into decision making.

● Develop or improve processes for on-going evaluation of data-collection efforts.

● Improve processes for using pertinent data in decision making and reporting and maintain data that is current on public facing platforms.

● Within six months, identify key data resources that can be monitored, mobilized, and disseminated in deidentified format as an incident emerges so that public health decision making is data driven and transparent to the public.*

● Within three months, review the Department’s public-facing website to ensure that parameters, limitations, and caveats of public facing data are clearly communicated.

Larimer County Department of Health and Environment (LCDHE)

Health Equity

Key Areas Suggestions Corrective Actions

Health Literacy

● Improve processes to develop messages that address health literacy, promote better health, and provide options for approved vaccines and/or specific treatments.

● During an emergent incident, develop a process for ensuring that all communications (e.g., documents, fact sheets, treatment options) are reviewed to meet appropriate health literacy needs of the intended audience using nationally accepted methods.*

Equity and Inclusion

● Improve processes for identifying the need for and providing equity in services for the community, businesses, and external partners.

● Improve processes for providing healthcare equity, translation services, and other support to under represented and marginalized communities

● Within 72-hours of an emergent incident, engage community-based organizations that support underserved and/or marginalized populations (e.g., La Familia, Salud, Sunrise, Catholic Charities, SummitStone, Northside Aztlan Community Center) to identify issues that may adversely impact the delivery of services, improve healthcare equity, and ensure equitable access to resources. *

● Within 12 months, identify a process for providing written translation services for languages other than English and Spanish that are spoken in Larimer County (e.g., Mandarin).

Larimer County Department of Health and Environment (LCDHE)

Community Outreach

Key Areas Suggestions Corrective Actions

Compliance

● Improve processes for supporting businesses and external partners, including with understanding and achieving compliance with frequently changing Public Health Orders.

● During an emergent statewide incident, county leadership (e.g., Public Health Director, Board of Health), will advocate through existing statewide organizations (CALPHO, CCI) for the issuing of future Public Health Orders at the state level (in lieu of local health agencies) to improve consistency statewide and eliminate confusion.*

● During an emergent incident, communicate through existing partnerships with the business community within 24-hours of any change to a Public Health Order that may impact business operations. *

Behavioral Health Support

● Develop or improve processes for identifying behavioral needs and opportunities within the community.

● Within 72 hours of an emergent incident, engage community behavioral health organizations (e.g., SummitStone, Health District of Northern Colorado, CARE Team) to identify behavioral health needs and address issues that may adversely impact the public. *

● Within 12 months, develop a written procedure on how to refer and expedite inquiries for resource support (e.g., behavioral health, human services, access and functional needs) to appropriate agencies.

Larimer County Department of Health and Environment (LCDHE)

Partnerships

Key Areas Suggestions

● Develop or improve processes for identifying internal and external partners and for creating opportunities for collaboration.

Corrective Actions

● Within 72-hours of an emergent incident, customize and clarify the roles and responsibilities of responding entities, both internal and external. *

Collaboration

● Strengthen collaboration between internal and external partners.

● Improve processes for the decision making groups and the EOC to collaboratively identify priorities.

● Improve processes for the implementation of strategies and tactics pertaining to EOC, ICS, and other related operations.

● Within 72 hours of an emergent incident, identify, assign, and integrate external partners that can support the ICS response structure. *

● Within 72-hours of an emergent incident, identify and assign primary and secondary points of contact between internal/external partners. *

● Within 12 months, develop generic job action sheets for individuals staffing ICS positions.

● Within two weeks of an emergent incident, customize job-action sheets for pertinent ICS Operations Section positions so they reflect the needs of the specific response. *

Larimer County Department of Health and Environment (LCDHE)

State/Federal Communication

● Develop or improve processes for maintaining relationships for enhanced collaboration efforts.

● Need to improve processes for addressing and overcoming local impacts caused by the breakdown of state/federal communications and information sharing.

● Within 24-hours of an emergent incident, establish lines-of-communication with the appropriate state agency (e.g., CDPHE, DHSEM, CIAC) to define a common goal(s), establish mutually reinforcing objectives, and leverage resources. *

● Within 24 hours of an emergent incident, collaborate with state/federal entities to identify the systems to be collectively used to manage data and to maintain situation awareness. *

Incident Management

Key Areas Suggestions

Decision Making Process

● Identify, in an on going manner, potential staff/partner agency decision makers.

● Integrate municipal partners to be more involved in the decision-making and implementation processes.

Corrective Actions

● Within 12 months, establish a formal, countywide Emergency Support Function 8 (ESF 8)/Health & Human Services Branch to represent and engage stakeholders and decision makers from across the healthcare spectrum (e.g., EMS, hospitals, behavioral health, human services, public health, fatality management, community partners).

● Within 72-hours of an emergent incident, engage ESF-8/Health & Human Services Branch partners to identify health, medical, and Human Service needs, as well as address issues that may adversely impact the public. *

Larimer County Department of Health and Environment (LCDHE)

After-Action

Coronavirus

Enforcement of Public Health Orders

● Identify challenges and potential solutions in the implementation of public health orders.

● Support collaborative efforts with other partner agencies to implement Public Health orders.

● Improve processes for Public Health Order enforcement and Notice of Violation follow-through.

● Improve the processes for transitioning from a position of Public Health Order enforcement to a position of education.

● During an emergent incident, convene partner agencies and municipalities regarding enforcement of Public Health Orders when those partners will be sharing responsibility for enforcement of the Orders. *

Health and

(LCDHE)

Solicitation for Improvements

● Develop or improve processes for soliciting staff and partner agency input for process improvements.

● Improve processes for evaluating and implementing suggested improvements at all levels.

● Within six months, establish a continuous quality improvement team as well as a process to receive, evaluate and implement process improvement suggestions at regular intervals.

Program Implementation

● Develop or improve processes for communicating with staff/partner agencies about decisions.

● Improve transparency to staff/partner agencies in high level decisions.

● Within six months, develop a plan that identifies which external partners and stakeholders (e.g., healthcare providers, elected officials, schools, childcare, higher education, business community, healthcare coalition) will be contacted and briefed during an emergent situation, and how frequently and in what format(s).

Resource Allocation

● Develop or improve processes for effective resource management.

● Improve processes for coordinating resources between operational priorities.

● Within three months, develop an algorithm to assess and prioritize requests for resources.

● Within six months, identify and establish accounts/relationships with at least two additional staffing resource pools to assist during an emergent incident (e.g. nursing programs, Volunteer Organizations Active in Disasters (VOAD), CSU public health students, etc.)

Larimer County Department of Health and Environment (LCDHE)

Finance

● Improve processes for grant management use and adjustment to changes to grant guidance.

Logistics

● Improve processes for addressing supply chain issues and logistics.

● Improve processes to address supply chain issues and related impacts on services.

● Provide staff with appropriate PPE.

● Improve processes for providing staff with needed resources/equipment and ensuring needs are continually met.

Coronavirus

● Within 72-hours of an emergent incident, Finance will notify the ICS Command and General Staff regarding cost tracking, expenditure protocol, and any grant related restrictions and guidance. *

● During an emergent incident, notify the ICS Command and General Staff of any change to existing grant standards and requirements within 72-hours of initial notification.

● Within six months, proactively establish accounts with three additional vendors to provide medical supplies and PPE.

● Within three months, establish an online supply request form for community based healthcare facilities that need assistance in acquiring supplies, PPE, and other resources.

● Within three months, identify all staff who need fit-testing and training for respirators.

● Within 12 months, explore options to establish a formal emergency supply cache location(s).

● Within six months, use the Salamander system to inventory emergency supplies.

● Within three months, create a job action sheet that provides a chronological checklist of activities that need to be addressed in the first 12 to 72 hours of an emergent incident, along with

After-Action

Logistics (cont.)

Clinic Operations

● Improve vaccine clinic design, staffing, and operations.

2019 Novel Coronavirus

other important activities that will take place in the days and weeks afterwards.

● Within 24 hours of an emergent incident, ensure there is a designated resources/hiring manager available for consultation and contractual hiring. *

● Within 96 hours of an emergent incident, refer to LCDHE mass dispensing plan to review previously identified sites, as well as identify at least one additional accessible option for Open POD sites in Larimer County to provide vaccination, testing, dispensing, etc. in an emergent incident.*

● Within three months, determine mass vaccination designs for pre-identified Open PODs.

● Within 96 hours of an emergent incident, determine the need for, mobilize, and deploy appropriate mobile and fixed site Strike Team(s) to assist underserved and under represented communities. *

● Within six months, work collaboratively with the Northern Colorado Medical Society to identify current and potential vaccine providers in the county.

● Within six months, identify and provide training options to clinical staff regarding vaccine hesitancy and vaccine confidence.

Larimer

Coronavirus

Staff Care / Support Staff

● Improve processes to address the identified gaps for managing staffing as a limited resource.

● Improve processes for reducing staff burnout and turnover through workload monitoring and management, implementing rotation of assignments, and sharing clear expectations.

● Improve processes to address staffing shortages and to improve transparency of decisions regarding layoffs.

● Improve processes for equitable compensation and benefits for regular and temp staff during times of high workload / emergencies.

● Improve processes to balance workload expectations for hourly and salary based employment.

● Improve processes for hiring staff and for providing onboarding and training.

● Within six months, provide all staff with the opportunity to partake in virtual/in-person training in risk communications, conflict resolution, psychological first aid, and/or de escalation.

● Within a week of an emergent incident, ensure there is a designated resources/hiring manager available to oversee the onboarding and management of staff involved in the response efforts. *

● Within three months, identify all staff who need fit-testing and training for respirators.

● Within 12 months, identify two staff members to begin training as Safety Officers in responding to an emergent incident.

●

Within a week of an emergent incident, establish clear expectations and policies concerning work location and overtime.*

Larimer County Department of Health and Environment (LCDHE)

Coronavirus

Staff Care / Support Staff (cont.)

● Improve processes for providing a safe work environment in facilities and in the field.

● Improve processes for management of infection and disease control efforts.

● Improve processes for identifying a variety of staff support needs and addressing those needs in a timely manner.

Larimer County Department of Health and Environment (LCDHE)

Training & Exercises

Key Areas Suggestions

Emergency Preparedness and Response Training

● Develop or improve processes for increasing the frequency of the delivery of training and exercises.

● Establish an ICS/NIMS Training policy for the Department that aligns with FEMA requirements and details courses based on roles within Incident Command.

● Create Job Action Sheets for key Incident Command positions.

Corrective Actions

● Within 12 months, develop generic job-action sheets for individuals staffing ICS positions.

Crisis Communications Training

● Provide training to officials and staff regarding conflict resolution, de-escalation, psychological first aid, and crisis management.

● Within two weeks of an emergent incident, customize job action sheets for pertinent ICS Operations Section positions so they reflect the needs of the specific response.

*

● Within six months, verify that all staff have successfully completed required ICS training courses, including IS-100, IS-200, IS 700 and IS 800.

● Within six months, identify staff who are required to take advanced ICS training (ICS 300 and ICS 400).

● Within six months, provide all staff with the opportunity to partake in virtual/in-person training in risk communications, conflict resolution, psychological first aid, and/or de-escalation.

Larimer County Department of Health and Environment (LCDHE)

REFERENCES

1 Hannah Ritchie, Edouard Mathieu, Lucas Rodés Guirao, Cameron Appel, Charlie Giattino, Esteban Ortiz Ospina, Joe Hasell, Bobbie Macdonald, Diana Beltekian and Max Roser (2020) "Coronavirus Pandemic (COVID 19)". Published online at OurWorldInData.org. Retrieved from: https://ourworldindata org/coronavirus

2. Centers for Disease Control and Prevention (CDC). COVID Data Tracker. Atlanta, GA: US Department of Health and Human Services, CDC; 2022, September 29 Retrieved from https://www.cdc.gov/coronavirus/2019 ncov/your health/covid by county.html

3 Colorado Department of Health and Environment (CDPHE) Colorado COVID 19 Data Denver, CO; 2022, August 31. Retrieved from https://covid19.colorado.gov/data

4 Larimer County Department of Health and Environment (LCDHE) Larimer County COVID 19 Dashboard. Fort Collins, CO; 2022, August 31. Retrieved from https://www.larimer.gov/health/communicable disease/coronavirus covid 19

5. Larimer Recovery Collaborative (LCR). COVID-19 Long-Term Recovery Plan. Fort Collins, CO; 2020, December 1 Retrieved from https://www.larimer.org/sites/default/files/uploads/2022/lrc covid recovery plan final 20201231 4.pdf

Larimer County Department of Health and Environment (LCDHE)